Case Formulation

Read the following case and answer all questions.
Laura is a Hispanic woman in her late-forties. Laura is married and has two daughters aged 15
and 17. She works in the high-stress, high-powered world of corporate finance. Laura presents
herself as a no nonsense business professional. She has come to the clinic that you are
presently working in as a social worker for an assessment because her husband and two
teenage children are very concerned about her drinking. Her husband has insisted that she seek
professional help.
Laura tells you that although she promises herself that she will only have one or two glasses of
wine per day, she routinely finds herself finishing the whole bottle and sometimes half or more
of a second bottle. Laura reports that it seems to take more wine these days to help her feel
relaxed at the end of a stressful day. She does not see this as a problem but she has missed a
few important business meetings lately. This has made her feel quite upset with herself and
guilty because she has lied to her boss about the reason for her absences.
About three years ago, Laura began to have trouble sleeping and the doctor prescribed the
medication Xanax (an anti-anxiety drug and central nervous system depressant). Her father
died about one year ago and her use of alcohol and Xanax has steadily increased since that
time. She often takes five or six times the prescribed dose of Xanax. When her physician
presented his concerns about the amount of Xanax she was taking on a regular basis she began
to search for other physicians in order to obtain more prescriptions for Xanax. She now takes
Xanax during the day as well as at night when she is feeling stressed.
Laura notices that her mind is quite fuzzy in the mornings and she cannot remember certain
things from the evening before. Of major concern to her family is that she recently totaled her
car in a crash on the way to work on a morning that she had a very bad hangover from
drinking the night before. Laura states “I guess I am really lucky to have walked away
unharmed”. Her children told her that they are beginning to feel embarrassed by her slurred
speech and staggering gait in the evenings when they bring their friends home. Laura admits
that she felt ashamed and guilty when her children told her that they felt embarrassed by her
behavior. Laura’s husband has told her the car accident terrified him and he wants her to get
a) What are your initial impressions of Laura?
b) Describe your approach and engagement of Laura and include professional and
ethical considerations in working with Laura.
c) Provide an assessment and DSM-5 diagnosis with a rationale for choosing the
specific diagnosis for Laura.
d) Does Laura need to be referred to a physician to be assessed for possible medical
detoxification/stabilization and if so provide an explanation as to why?
e) Provide a treatment plan including models or treatment used and interventions.
f) Should Laura’s family be involved in her treatment? If family involvement is
indicated outline the rationale for including Laura’s family in her
treatment plan.